Cervicothoracic myofascial pain occurs due to trigger points in certain areas of the body and are easily stimulated, causing pain. It is seen more in areas around the neck and the shoulders, making causing discomfort and painful movements. Although muscle pain is a common, cervicothoracic myofascial pain, may gradually continue or worsen, if not managed well.

Cervicothoracic myofascial pain is a condition characterized by pain in the muscles and surrounding fascia or soft tissue, particularly of the cervicothoracic region.

Cervicothoracic is the region around the neck, upper back and the chest region. In cervicothoracic myofascial pain, muscles and the fascia related to the cervical spine or neck vertebrae and the thoracic region are painful. Cervicothoracic myofascial pain occurs as a result of trigger points that remain in certain areas of the body and are easily stimulated, causing pain.

While muscles support the spine, fascia is a connective tissue that helps to bind internal body parts. Myofascial pain is often related to muscle and the connective tissue or fascia, resulting in pain in surrounding areas. Cervicothoracic myofascial pain predominantly occurs between the neck and the shoulders, extending to the chest; as the main trigger points are located in this region. In myofascial pain, stimulation of sensitive or trigger points can sometimes cause pain even in unrelated areas or nearby areas. This is referred pain and is often felt when the other end of the muscle or the fascia is stimulated.

Cervicothoracic myofascial pain can be experienced by anyone, at any age; however, this type of muscle pain syndrome may be noted more commonly in women and young people. The cervicothoracic myofascial pain may be felt more on one side but is present on both sides too. The pain may be seen in muscles after an injury, fall or blow to the area and is commonly triggered by such events. Although muscle pain is a common phenomenon, cervicothoracic myofascial pain, is a condition that may gradually continue or worsen, if not managed well. Hence, it is important to understand the causes, symptoms and treatment options of cervicothoracic myofascial pain.

Cervicothoracic Myofascial Pain

Causes of Cervicothoracic Myofascial Pain

Cervicothoracic myofascial pain can be caused by a variety of factors affecting the muscles and soft tissues of the body. The commonest causes of cervicothoracic myofascial pain include:

  • Injuries – Trauma to the neck, shoulders, spine and the arms is a common occurrence that can lead to myofascial pain in the neck and upper back. Injuries can be a result of fall, direct blow, whiplash or other accidents, causing damage to the muscles and soft tissue structures in the neck and upper back or the cervicothoracic region. Intervertebral disc injuries of the cervical spine can also cause cervicothoracic myofascial pain.
  • Sports – Most sports, particularly racquet sports and ball games make repeated use of hands, neck and shoulders and can cause strain to the muscles and fascia around these areas. Inadequate warm-up or physical conditioning and improper techniques applied during the game, can increase the risk of strain or injuries to the cervicothoracic area. Repeated strain and injuries can result in trigger points and cause pain in the neck, shoulder and upper back region as commonly seen in cervicothoracic myofascial pain.
  • Overuse – Just as muscles and tissues are at risk of pain and injuries due to repeated use in sports, certain other activities too can cause cervicothoracic myofascial pain. Recreational activities, hobbies or certain occupations may require increased use of hands, arms, shoulders and the neck. This not only increase the strain on the region but can also weaken the muscles and cause cervicothoracic myofascial pain due to trigger points. Occupations or activities that include looking up or bend neck low, or sitting and working with hands for long hours causing overuse strain can cause cervicothoracic myofascial pain. For example, repairing, knitting, sewing, typing, writing, work with computers and similar activities can cause repeated strain on the neck and the upper back, increasing the risk of cervicothoracic myofascial pain.
  • Posture and Bio-mechanics – Posture plays a very important role in maintaining good health of the neck and spine. The ergonomics and bio-mechanics related to body posture needs to be understood carefully, as any deviation from the normal posture or healthy movements can cause undue strain on the neck and back muscles. Some of the common causes of cervicothoracic myofascial pain related to posture include improper ways of sitting, reading, working at a desk, lifting objects and even sleeping postures. People commonly experience cervicothoracic myofascial pain due to the use of inappropriate chairs, bed or pillows and improper techniques of handling things.
  • Medical Conditions – Certain medical conditions can add to the causes of cervicothoracic myofascial pain. Conditions that affect the muscle strength or those that caused delayed healing of muscle injuries can result in trigger points and sometimes cause cervicothoracic myofascial pain. Certain autoimmune disorders, connective tissue disorders that affect the soft tissue or fascia around the neck and back can cause cervicothoracic myofascial pain. Other health conditions like heart disorders, thyroid problems, diabetes or other emotional problems, too can increase the risk of muscle pain and cause cervicothoracic myofascial pain.

Risk Factors of Cervicothoracic Myofascial Pain

In addition to the causes of cervicothoracic myofascial pain, certain risk factors can increase the risk of pain in neck and upper back. These include:

  • Lack of activity, regular exercise and sedentary work– This can make the muscles weak and make them unable to take on any strain and can cause cervicothoracic myofascial pain. Regular exercise and physical activity can help to keep muscles strong and supple and keep them fit to take on the daily pressures.
  • Activities with repeated use of hands – People engaged in hobbies, sports or activities that require repeated use of hands are at increased risk of cervicothoracic myofascial pain. Proper conditioning and muscle strengthening in such cases can help to prevent cervicothoracic myofascial pain due to such activities.
  • Faulty lifestyle – Smoking, alcohol and consumption of junk food can affect a person’s ability to sustain overstrain and can easily result in injuries and pain conditions. Extreme stress, overexertion and lack of adequate sleep can form trigger points and can cause cervicothoracic myofascial pain, in people with previously injured or weak neck and back muscles.

While these are risk factors of cervicothoracic myofascial pain, some other factors can also aggravate the condition of cervicothoracic myofascial pain. The most common factors that can make the cervicothoracic myofascial pain worse include:

  • Continuous working at the desk, use of computer or typing related work, or similar work that affects the posture of the neck and upper back. Changes in posture is the main contributing factor that causes cervicothoracic myofascial pain.
  • Continuation of activities that cause pain, like performing repeated hand movements, forceful jerky movements of the arms or neck, overhead activities, etc.
  • Improper sleeping postures, continued rest period, lying on the same side for a long time can weaken the muscles.

Certain factors are known to influence the severity of cervicothoracic myofascial pain. Although, it may not be clear, some patients experiencing cervicothoracic myofascial pain or those with neck and back injuries may complain of increased pain due to exposure to cold or wet weather. Having a cold bath may also aggravate condition of cervicothoracic myofascial pain in some people. Similarly, people who are emotionally disturbed or stress out, can feel the severity of cervicothoracic myofascial pain.

Symptoms of Cervicothoracic Myofascial Pain

Symptoms of Cervicothoracic Myofascial Pain

Symptoms of cervicothoracic myofascial pain can vary from person to person. It may present as sharp, severe pain in a specified area or may also cause dull, aching pain in a diffused neck and upper back region. Cervicothoracic myofascial pain is mainly felt in the neck, shoulders, upper back and the scapular region or the area between the two shoulder blades. Pain can also extend in the front reaching the upper part of the chest area. Pain is often felt deep into the muscles, which usually bothers when the neck is turned or hands are raised above the head. The muscles around the neck and shoulders feel tender and pain easily with slightest exertion.

Cervicothoracic myofascial pain may begin intermittently in the beginning and gradually remain persistent, if left untreated. Pain in the neck and scapular region may be very disturbing and can cause difficulty in daily activities. Muscular tenderness, a classical symptom of cervicothoracic myofascial pain may be presented with appearance of tender knots and trigger points in the painful muscles. Activities, injuries or jerks that stimulate these trigger points can aggravate the pain and cause more discomfort.

Another major symptom of cervicothoracic myofascial pain is numbness and tingling in the hands and fingers. This commonly occurs due to compression of a nerve in the cervicothoracic region and can affect along the entire course of the nerve. Weakness of muscles is a common symptom of cervicothoracic myofascial pain. Affected person may find it difficult to use the hands efficiently or sometimes fine motors kills may get affected due to weakness of muscles of the hands and shoulders. Applying pressure over the neck, shoulder blades and upper back area, often elicits pain and discomfort into the deep muscles. It can also trigger numbness and tingling in hands making gross and fine motor skills like handling objects, writing or buttoning can be difficult.

Symptoms of cervicothoracic myofascial pain may also include restricted range of motion of the affected area. For example, the person may find it difficult to turn the neck up, down or sideways, raising shoulders or hands may be painful in cervicothoracic myofascial pain. In people experiencing cervicothoracic myofascial pain, a history of muscle injury or a condition that affects muscles can worsen the symptoms. Slightest strain, jerks or repeated use can easily cause trigger points and aggravate the symptoms of cervicothoracic myofascial pain.

People experiencing cervicothoracic myofascial pain, often complain of difficulty in sleeping or disturbed sleep due to muscular pain. Pain and discomfort during sleep and deprived sleep can further trigger muscle pain and the cycle continues. In some, this problem can further become a chronic pain condition and cause more problems.

Treatment of Cervicothoracic Myofascial Pain

Treatment of cervicothoracic myofascial pain usually includes a comprehensive approach of medications, physical therapy, exercises, lifestyle management and complementary therapies. As the condition of cervicothoracic myofascial pain is related to trigger points that remain in the muscles and tissues, it is important to treat it with an all-rounded approach.

Medical Management

  • Pain-killers and anti-inflammatory medicines can help to relieve pain and swelling. These can be taken in the form of oral tablets or can be applied as gels, creams or patches. Local application of pain relieving medicines can help those who are not able to tolerate oral medicines due to increased risk of gastric disturbances.
  • Muscle relaxants are usually given to help relax the tense muscles, relieve pain and other symptoms of cervicothoracic myofascial pain.
  • Anti-depressants and other medicines that act on the central nervous system can help to alleviate pain, relax muscles, induce better sleep and improve cervicothoracic myofascial pain.
  • Other medicines to treat specific medical conditions, if any, may be considered in some cases. Injecting steroids in the trigger points may be recommended in some people, if appropriate.

Physical Therapy for Cervicothoracic Myofascial Pain

Physical therapy usually applies various modalities that help to relieve symptoms of cervicothoracic myofascial pain. For acute pain conditions, modalities to relax deep muscles may be used, followed by basic exercises and proper training. Some of the approaches in physical therapy for cervicothoracic myofascial pain include ultrasound, nerve stimulation or short wave diathermy. Use of ultrasound can help to relieve pain and swelling in the muscles and around the joints. It reduces discomfort, improves blood circulation and also helps to improve the range of motion. Other modalities like nerve stimulation can help to release the pressure of the compressed nerve, improve tingling and numbness and other symptoms of cervicothoracic myofascial pain.

Physical therapy, mainly also focuses on posture training of the person. As the neck and the upper part of the spine is involved, it is important to maintain good posture and improve regular movements. Learning correct ways of sitting, standing, lifting objects, working with computer or typing, etc. can help to avoid unnecessary strain on the neck and back muscles. Poor posture is a habit that needs to be unlearned and needs great efforts. While exercises are important, learning and maintaining proper posture can ensure relief from cervicothoracic myofascial pain. Correct postural alignment to maintain a healthy neck and spine is taught to persons experiencing cervicothoracic myofascial pain.

Stretching and therapeutic exercises may be applied in physical therapy to treat cervicothoracic myofascial pain. Exercises in warm water may also be recommended in some cases.

Complementary Therapies for Cervicothoracic Myofascial Pain

Considering a person’s causes and symptoms of cervicothoracic myofascial pain, complementary therapies can be planned, with the help of an expert. These include,

  • Heat – Heat is an effective agent that provides relief from complaints of cervicothoracic myofascial pain. Heat may be applied in the form of hot water bag, heat pads or taken as warm showers. It is greatly known to relax tense muscles, reduce pain and improve sleep when applied in the evening.
  • Massage therapy – Therapeutic massage therapy may be applied, using techniques like kneading and placing hands in appropriate positions to release tight muscles and relieve symptoms of cervicothoracic myofascial pain.
  • Alternative Therapies – Some alternative therapies are also popularly used as a treatment for cervicothoracic myofascial pain, for example, magneto therapy, acupressure, creative visualization, stress management techniques etc. Persons who believe and feel comfortable can use these as a treatment for cervicothoracic myofascial pain, under the guidance of an expert.

Exercises for Cervicothoracic Myofascial Pain

Cervicothoracic myofascial pain causes pain in neck, upper back, shoulder, around shoulder blades and chest area in the front. These areas are put to maximum use in most of the activities, which makes them more vulnerable to repeated strains and even injuries. Hence, it is important to maintain strength and flexibility of the muscles and tissues in these areas.

Exercises for cervicothoracic myofascial pain can help to reduce pain in persons experiencing this condition and can also help to prevent cervicothoracic myofascial pain in others. Some of the exercises recommended to treat cervicothoracic myofascial pain include:

  • Gentle neck movements – Move the neck gently in up-down direction and sideways to improve flexibility and reduce pain. Bending the neck towards the sides and holding the position for a few seconds, helps to stretch the muscles, which eventually relax. These exercises provide relief in cervicothoracic myofascial pain.
  • Shoulder shrugs – Raise the shoulder, as if shrugging them, hold for a few seconds and release. This helps to release tension in the shoulder blade area and relieve pain. Cervicothoracic myofascial pain is mainly concentrated around the shoulders, which make them stiff and restrict their movements. Shrugging helps to relieve stress and relax the trigger points.
  • Upper body twist – Stand with feet apart and hands placed on the waist. Twist the upper body to turn towards the left side, come back to the center and then turn towards the right side. This twisting movement of the upper back, releases tense muscles of the neck and upper back and improves flexibility thus helping to treat cervicothoracic myofascial pain.
  • Shoulder stretches – Stand with feet apart and interlock the hands behind. Keeping the back straight, gently raise the interlocked hands upwards, so that the shoulders are pulled back and a stretch is felt at the shoulder blades. Hold this position for a while, keeping the body relaxed and then release, coming to the original position.
  • Deep breathing – Deep breathing exercises are a great way not only for relaxation and stress management, but also to improve the neck and back alignment. Deep breathing using the diaphragm, or diaphragmatic breathing can help to release the muscles around the neck and the chest. It helps the lungs to fully expand, which improves oxygenation and blood circulation along with correction of the neck and back posture.

Other exercises can include aerobic exercises and weight training; however, the exact exercises that can be performed and those that are best avoided need to be assessed properly. Although swimming may not be well tolerated with already strained muscles in cervicothoracic myofascial pain, water exercises or aqua aerobics can help a great deal.

Exercises are best planned based on the individual muscle strength and requirement. Hence, it is advisable to follow an expert’s advice and maintain a proper exercise routine, without overstraining the muscles.

Lifestyle Management for Cervicothoracic Myofascial Pain

After knowing the risk factors for cervicothoracic myofascial pain, it is important to maintain a healthy lifestyle, in order to keep joint and muscle pain at bay. Cervicothoracic myofascial pain can be prevented or the complaints can be minimized by following a healthy routine.

A healthy lifestyle means following a healthy diet and a balanced meal, with all nutrients to keep body and mind healthy. Drinking enough liquids and water every day, is important to keep muscles and joints lubricated and can help to reduce symptoms of cervicothoracic myofascial pain.

It is good to avoid smoking and alcohol as it can only worsen pain conditions. These can be replaced by healthy drinks, fruits and water. Taking salt and sugar in moderation can help to maintain healthy muscles, without increasing the risk of other lifestyle disorders.

Another most important factor is to maintain ideal body weight to manage cervicothoracic myofascial pain. Pain conditions often worsen with increased body weight, making movements as well as recovery difficult. So, work on reducing and maintaining weight to prevent cervicothoracic myofascial pain.

As sedentary life increases risk of cervicothoracic myofascial pain, it is important to remain active during the day. In addition to this, a healthy exercise pattern must be followed that includes a wide range of activities and are best performed under supervision. Sleep is equally important; hence a proper balance or work, rest, exercise and night’s sleep must be maintained to prevent or manage cervicothoracic myofascial pain. Practicing relaxation techniques can help to manage stress better and help to manage cervicothoracic myofascial pain. Channelizing positive energies towards fighting pain conditions can help to improve cervicothoracic myofascial pain too.

It is essential to know the limits. As every individual is different, understanding where to stop can help to manage pain better. Overdoing things or overstaining muscles must be avoided when managing cervicothoracic myofascial pain. Going slow, learning to take things easy and working towards a healthy routine must be practiced to effectively treat cervicothoracic myofascial pain.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: August 6, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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